What Is an Acoustic Neuroma?
An acoustic neuroma is a benign, slow-growing tumor that presses on the nerves of your inner ear and affects your hearing and balance. Acoustic neuromas can form when your body produces too many Schwann cells, which wrap around and insulate the nerve fibers. As the tumor grows, you could experience symptoms such as:
- one-sided hearing loss,
- tinnitus (ringing in the ear),
- dizziness/loss of balance, and
If the tumor continues to grow, it could place pressure on certain parts of your brain and become life-threatening.
At University of Utah Health, we use the most up-to-date surgical and imaging tools to give you the best outcome and renew your quality of life. The advances in technology and surgical techniques have allowed our surgeons to successfully remove acoustic neuromas and perform many other types of skull base surgeries with ease and precision.
Your First Visit
Before your surgery, you will meet with two different specialists at separate appointments. This treatment team will include a neurosurgeon and a neurotologist.
As you prepare for your visit, keep these things in mind.
- Write down any symptoms or questions you'd like to discuss with the doctor.
- Make a list of all your medications.
- Ask a family member or friend to join you for support and a second set of listening ears.
At your initial appointments, our physicians will explain your treatment options including the risks and benefits of undergoing a skull base surgery for an acoustic neuroma.
If you and your specialist decide that surgery is the best option for your health, we will help schedule a surgery date for you. This type of skull base surgery is rarely an emergency because most acoustic neuromas are slow-growing.
Your Skull Base Surgery Specialists
Preparing for Your Surgery
Before you have surgery, you will go through many of the following steps.
Meeting with Your Anesthesiologist
You will meet with the anesthesiologist to discuss anesthesia during your surgery and check your heart and lungs.
You may receive an audiogram (hearing test) in the weeks or days before your surgery depending on the type of tumor. You will listen to a series of beeps at high and low frequencies and volumes. This test helps us to better understand your current hearing ability, particularly if we plan on preserving your hearing.
We have most likely already done some kind of imaging, such as magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan) to diagnose your tumor. However, we may need to do additional imaging before your surgery to get a more detailed picture of the tumor. The images we obtain will be sent to a specialized computer system for our medical team to use during your surgery.
Medication & Diet
We may ask you to stop taking certain medications to decrease bleeding risks during surgery. Your doctor will review your list of medications and give you instructions for how to temporarily wean yourself off of them. We may also instruct you to stop eating and drinking by midnight before your procedure.
What to Bring on the Day of Your Surgery
On the day of your surgery, you will need to bring things such as:
- your insurance card and personal identification,
- loose-fitting clothes,
- a robe, and
- sturdy walking shoes (your doctors will encourage you to start walking soon after surgery).
Please make sure you leave all other valuables at home.
During Acoustic Neuroma Surgery
The kind of procedure we perform will be largely dependent on the type of tumor, its location and size, and your age and overall health. Our team of medical specialists, including a neurosurgeon, a neurotologist (an ear, nose, and throat specialist), and an anesthesiologist will work together to remove the acoustic neuroma. It is our mission to decrease your symptoms and improve your quality of life with minimal long-term impact to you.
Your doctors will choose an open surgery treatment approach known as a craniotomy.
We will make incisions (cuts) near your ear and remove a piece of bone, which will be replaced at the end of the surgery, to access your brain and tumor. We want to retract as little of the brain as possible to prevent potential damage.
There are three different kinds of craniotomies we can perform:
- Retrosigmoid craniotomy — We will make a incision (cut) behind your ear to access the acoustic neuroma. This approach is often used for smaller tumors and for when your hearing can be preserved.
- Translabyrinthine craniotomy — We also make a cut behind your ear for this procedure. Some of the inner ear bone must be removed for this type of procedure. This approach can cause hearing loss but will often preserve your facial nerves.
- Middle fossa craniotomy — During this procedure we access your tumor through a incision above the ear. This is another viable option for people with small tumors and also offers the ability to preserve your hearing.
While the surgery takes place, we will monitor the function of your nerves to ensure your safety.
We may use a surgical microscope to provide the greatest visibility of the tumor. The surgery generally ranges from four to six hours depending on the tumor size.
Your Hospital Stay
After surgery, you will be moved to the Intensive Care Unit (ICU). The following day we will transfer you to a medical surgical floor for the remainder of your stay at the hospital. You should expect to stay in the hospital for about three to five days, depending on the kind of surgery.
During your stay, you will:
- drink clear fluids until you can eat normally without feeling nauseous,
- receive pain medication immediately after surgery (we will give you a prescription for pain medicine to use as needed at home), and
- walk frequently in the hospital to help you regain your sense of balance and decrease any dizziness.
Acoustic Neuroma Surgery Complications
Facial Nerve Weakness
We will need to dissect the facial nerve from the tumor in order to preserve it. This manipulation can sometimes cause swelling, which can result in weakness or paralysis (complete or partial loss of your muscle function). This is usually temporary but can take weeks to months to recover.
If this is the case, your eye may not fully close for a period of time. You can prevent your eyes from drying out with:
- over-the-counter artificial tears and
- a moisture chamber (special eyeglasses for dry eyes)
If you have fluid dripping from your nose, particularly when bending over, contact your doctor’s office. This could mean you have a spinal fluid leak.
Every patient heals at his or her own pace after surgery. Following your doctor’s orders and remaining patient are the keys to a speedy recovery.
In many cases, we use dissolvable sutures (stitches) that do not require removal.
You may have staples or sutures that the nurse or nurse’s aide will remove seven to 10 days after surgery. You’ll need to cover your wound in the shower until your staples or sutures are removed. You can gently wash your hair after we take them out.
Your wound will heal properly, if you:
- limit your time in the sun,
- do not go swimming, use a hot tub, or take a bath for two weeks, and
- do not color or perm your hair for four weeks after surgery.
We will prescribe you narcotic pain pills to help relieve any severe discomfort and pain. Follow the instructions below to manage your pain safely and effectively.
- Only use narcotics as needed.
- Do not drive while taking narcotics.
- Use over-the-counter medicine for moderate or mild pain.
- Apply an ice pack for 20 minutes on the incision before taking a 20-minute break. Then repeat, if necessary.
Ear sounds and discomfort are normal after acoustic neuroma surgery. However, if any of the sounds or pain worsens or continues, talk to your doctor. You may experience ear symptoms like:
- clicking noises,
- tinnitus (ringing in the ears),
- a feeling of fullness in the ear, and
- occasional shooting pains.
You should also avoid the following habits until the incision site near your ear heals.
- Do not blow your nose until your doctor has said the wound is healed.
- Do not try to pop your ears.
- Do not get overly tired. If you catch a cold, treat it as you normally would.
Dizziness & Balance
You may experience varying levels of dizziness after surgery for a period of days or weeks. Your balance may also be affected. Staying active will help you maintain your strength and heal your body. For example, physical therapy could help improve your balance and coordination.
Walking daily will help you recover from surgery. Increase your activity gradually from short walks to longer walks—30 to 45 minutes in duration—once or twice a day.
For the first two weeks after surgery, do not:
- lift anything heavier than 10 pounds,
- strain or bend at your waist, or
- run or do any highly aerobic exercise for at least six weeks or more.
We will help you schedule a follow-up appointment four to six weeks after surgery to check on your wound and overall recovery. At that time, we may discontinue any medication we gave you initially after surgery.
We will also perform routine postoperative surveillance imaging. Depending on your recovery and the type of surgery you had, we may need to continue imaging for six months or as long as five years. The time varies greatly from person to person.
Acoustic Neuroma Recovery
Healing from skull base surgery will take time and patience. For some patients, that may mean weeks. For others, healing may require months.
What Does a "Full Recovery" Mean?
Feeling like yourself, with your normal level of energy, may take weeks or months after skull base tumor surgery. Over time, you will be able to:
- walk without assistance from someone else or a nearby wall,
- use the stairs easily,
- move your eyes and head normally,
- regain your balance,
- walk at your normal pace,
- navigate complex environments such as a grocery store,
- participate in recreational activities and sports, and
- perform your daily household tasks without difficulty like cleaning your house and working in the yard.
After surgery, most patients start driving within three weeks and go back to work after four to six weeks. However, that time may depend on how well you’re recovering and the type of work you do. Talk to your doctor about when may be the best time for you.
If you have any problems, please contact us at 801-581-6908 Monday to Friday from 8 am to 5 pm.
After hours and on weekends, call 801-581-2121 and ask to speak to the on-call neurosurgeon or otolaryngologist.